Pseudotumor cerebri (PTC) is characterized by raised intracranial pressure (ICP) without an identifiable mass, evidence of hydrocephalus, or abnormal cerebrospinal fluid content. In the past, most cases of PTC appeared to have no identifiable etiology, and thus, they were classified as "idiopathic intracranial hypertension" (IIH). Recently, however, a subset of patients with presumed IIH has been found to have evidence of cerebral dural sinus stenoses, particularly involving one or both transverse sinuses (TS). The belief that the stenoses are the cause, rather than an effect of the increased ICP, has led investigators to recommend stenting of the stenosed sinus for the treatment of the condition. We describe detailed visual and neurological outcomes after stenting for PTC associated with hemodynamically significant dural sinus stenosis.All patients with PTC had initial neurological, neuro-ophthalmological, and imaging assessments. Regardless of the findings, all were treated with medical therapy. If medical therapy failed and TS stenosis was detected on contrast-enhanced magnetic resonance or computed tomographic venography, catheter cerebral angiography with venous manometry was performed. If a mean pressure gradient (MPG) of 4 mm Hg or greater was present, unilateral transverse sinus stenting was performed.Twelve patients with PTC and TS stenosis associated with an MPG of >4 mm Hg who failed medical therapy were identified. TS stenting significantly decreased the pressure gradient in all cases. Unilateral stenting was sufficient to reduce pressure gradients even when the stenosis was bilateral. At a mean follow-up of 16 months (range, 9-36 months), tinnitus had improved in all patients, and 10 of 12 patients had improvement in visual function. Seven patients had significant improvement in headaches.In this small series of patients with PTC associated with TS stenosis, endovascular stent placement was generally effective in treating visual dysfunction and tinnitus, although not headaches. The optimum gradient and vascular characteristics amenable for selection of patients for stenting needs further research.
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机译：假性脑瘤（PTC）的特点是颅内压（ICP）升高，没有可识别的肿块，脑积水或脑脊液含量异常。过去，大多数PTC病例似乎没有可识别的病因，因此被归类为“特发性颅内高压”（IIH）。但是，最近发现一部分患有IIH的患者有脑硬脑膜窦狭窄的证据，特别是涉及一个或两个横窦（TS）。认为狭窄是引起ICP的原因，而不是增加ICP的影响，这一信念促使研究人员建议将狭窄的鼻窦支架置入以治疗该病。我们描述了PTC植入后与血液动力学显着的硬膜窦狭窄相关的详细视觉和神经学预后。所有PTC患者均经过了初步的神经，神经眼科和影像学评估。不论发现如何，均接受药物治疗。如果药物治疗失败并且通过对比增强磁共振或计算机断层扫描静脉造影术检测到TS狭窄，则需进行静脉测压的导管脑血管造影。如果存在平均压力梯度（MPG）大于或等于4 mm Hg，则应进行单侧横窦支架置入术。对12例PTC和TS狭窄且MPG> 4 mm Hg的狭窄患者进行药物治疗。在所有情况下，TS支架置入均可显着降低压力梯度。即使狭窄是双侧的，单侧支架也足以降低压力梯度。平均随访16个月（范围9-36个月），所有患者的耳鸣均得到改善，而12例患者中有10例的视觉功能得到了改善。七名患者的头痛得到了明显改善。在这一系列与TS狭窄相关的PTC患者中，血管内支架置入通常可有效治疗视觉功能障碍和耳鸣，尽管不是头痛。适于选择支架患者的最佳梯度和血管特征需要进一步研究。
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